Fat in men has been christened with a variety of names. We call it the beer belly, the spare tire, or simply the gut. We joke about it, calling it Dunlap’s disease (“His stomach done lapped over his belt”) or give it a playful label such as love handles. But there is nothing humorous about abdominal fat. It is a dangerous health risk that can lead to complications such as cardiovascular disease, some types of cancer, hypertension, type 2 diabetes, and erectile dysfunction.
To better understand the dangers of abdominal fat, let’s take a look at what body processes are involved in male fat storage.
The Importance of the Body Fat–to–Lean Muscle RatioWhen most people think about how fat or thin they are, they think about how many scale pounds they weigh. While your weight on the scale is certainly important and will give you some information about your general health, it is even more important for you to determine your body composition—that is, how many pounds of fat you carry in relationship to how many pounds of lean muscle. The following table categorizes body fat percentages for men:
Body Fat (%) Level
<11 Athletic
11–14 percent Good/lean
15–17 percent Average
18–22 percent Fair/fat
22+ percent Obese
Most men believe that it is inevitable that their body fat–to–lean muscle ratio will rise as they age and experience the hormonal changes associated with andropause. In fact, the tables you see in some health books, on the Internet, or in your doctor’s office will reflect this belief, allowing for a higher “healthy” percentage of body fat in older people. But men do not have to settle for a higher fat percentage as they reach midlife and their later years. The amount of body fat is directly related to diet and exercise.
While it’s unlikely that a seventy-year-old man is going to have 11 percent body fat, he shouldn’t be content to settle for an unhealthy amount of fat. It is never too late to change your body composition through a good nutritional and exercise program. And, I might add, it’s never too early. I have seen men in their twenties and thirties with high percentages of body fat, especially in sports such as football where large size is important. A future post has an at-home test to measure your body fat–to–lean muscle ratio.
If your percentage of fat versus lean muscle is the true indicator of whether you have a healthy body composition, then how much you weigh on the scale does not really give you an accurate idea of how overfat you may be. Let’s look at two athletes who weigh 240 pounds.
The first man, Jon, is a body builder with 10 percent body fat; all the rest is lean muscle. Jon’s metabolism is very efficient because lean muscle is metabolically very active. His appearance is firm and muscular, his waistline is trim, and his abdomen is flat. His general health is excellent, his lipid profile (triglycerides and cholesterol) is well within the normal range, and he feels energized and alert throughout the day.
The second man, Paul, has 40 percent body fat and looks and feels completely different. Even though he is an NFL lineman, his metabolism is not as efficient as it should be because body fat is not metabolically active. His body looks overfat, his waistline measures 48 inches, and his stomach bulges over his belt. His cholesterol and triglyceride levels are dangerously high. Because he carries so much weight in the abdominal area, he is seriously at risk for type 2 diabetes and cardiovascular disease (if he doesn’t already suffer from these diseases not yet diagnosed). Even though he is a professional athlete, his body does not feel fit and his heavy stomach puts a strain on his lower back. He often complains of back, knee, and hip pain from all of the extra fat he drags around.
Where Do You Carry Your Weight?By now it should be clear that the most important issue is not just how fat you are but where you carry your fat and the point at which it becomes a problem.
The classic male fat pattern is the apple or android shape—weight above the waist. Therefore, the waist measurement in a man is one of the most accurate indicators of how much at risk he is for a variety of serious diseases. In 2002, when the American Heart Association published their revised “Guide to the Primary Prevention of Cardiovascular Diseases” in Circulation magazine, they warned that a waist measurement of 40 inches or more in a man indicated a greater chance of developing cardiovascular disease. Dr. Sidney C. Smith, the association’s chief science officer, was quoted as saying, “It’s turned out that waist circumference is as good a predictor of risk as body mass index.”
In my Fat-Burning Metabolic Fitness Plan, I have found that waist circumference is a better indicator of health risks than BMI. For example, the waistline measurement is an especially good tool in evaluating older men who have not gained weight but have undergone unhealthy changes in body composition. I have seen many clients in their sixties and seventies whose weight has not gone up in years—that is, their BMI has not changed—but they have gained inches in the waistline, indicating a loss of lean muscle and an increase in body fat. Some people swear by the waistto-hip ratio as a good evaluation tool, but I always look primarily at the waist measurement in men, because when a man has a reverse fat pattern, his waist-to-hip ratio can remain constant over time while he is actually storing quite a bit of fat in that part of the body.
Vulnerability to certain diseases can even be present in a man whose waistline is less than 40 inches. Depending on how clients measure up during their initial health evaluation and how much body fat–to–lean muscle they have, my doctors usually suggest that some men take a glucose tolerance test or a hemoglobin A1C test, which follows a person’s blood sugar over a two- to three-month period if his waistline has reached 37 inches. This is because there is such a high correlation between excess abdominal fat and insulin resistance, a precursor to type 2 diabetes.
I have also seen a direct correlation between erectile dysfunction and abdominal fat. A 2000 study funded by the National Cancer Institute found that men with a waistline measurement of 42 inches or more were twice as likely to suffer from erectile dysfunction than men with a waistline measuring 32 inches. Men who were inactive were also more prone to this problem than men who exercised at least thirty minutes a day.
This information was confirmed by the results of a 2003 study of nearly 32,000 men aged 53 to 90 reported in the Annals of Internal Medicine. Researchers found that one out of three older men suffered from erectile dysfunction. However, men who were not overfat and who exercised regularly were 30 percent less likely to have this condition.
Further Dangers of Abdominal Fat: Metabolic Syndrome XOverfat men often exhibit one or more of a whole cluster of symptoms that doctors call Metabolic Syndrome X. These include a waistline of 40 inches or more, triglycerides greater than 150 mg/dl, HDL (good cholesterol) less than 40 mg/dl, a fasting glucose greater than 110 mg/dl, and blood pressure greater than 135/85 mm/Hg. Anyone who has three or more of these symptoms is diagnosed with Metabolic Syndrome X. In a future post, I include a questionnaire to help you determine whether you have this syndrome. It is important because this combination of symptoms can be a strong indicator that you are at risk within the next ten years for a major cardiovascular event such as heart disease.
In a recent article published in the British Medical Journal, Dr. Jean-Pierre Despres of the Quebec Heart Institute referred to Metabolic Syndrome X as hypertriglyceridemia and confirmed the risk for heart disease that the symptoms above represented when coupled with a waistline of over 40 inches. Dr. Despres also pointed out the weakness of the waist-tohip ratio as a reliable indicator of risk for disease, since men who had adopted a female fat pattern tended to keep gaining fat in the waist and hips while their ratio remained within the “safe” range.
Don’t Be Defeated by the “Beer Belly Gene”I have heard many men make the excuse that they carry abdominal fat because of their DNA. Every man in their family has a huge gut and therefore they themselves are doomed to this “genetic” condition of being overfat.
In most instances, I have discovered that this is not the case. Overfat individuals almost always grow up in—and continue to live in—an environment where their family, friends, and loved ones all have poor eating and exercising habits. They are obese because of their lifestyle and unhealthy nutrition habits, not because of some mysterious fat gene.
However, in a minority of men, scientists have found something that they have dubbed the “beer belly gene.” A recent study conducted by a team of researchers at the University of Naples and published in the Annals of Internal Medicine found that of 959 men between the ages of twenty-five and seventy-five, a small percentage did have a genetic variation that predisposed them to develop abdominal fat.
This genetic predisposition does not spell doom, however. The bottom line was that these men had a greater propensity to develop an unhealthy amount of abdominal fat if and only if they led an unhealthy lifestyle. None of these men got beer guts from eating nutritious foods and exercising regularly. And they had just as much chance of losing fat and increasing their lean muscle mass as men without the beer belly gene. In the case of these men, if they wanted to keep the fat off, they would just have to be a bit more vigilant in their lifestyle.
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